The Dominant Economic(s) Prism in Health Reforms: from Economic Constraint to Economic Paradigm

With the economic and political crisis, economic standards are consistently emphasised in the literature on health systems. They are also emphasised by field actors when defining and implementing health policy. This study illustrates the impact of economic frameworks on the way health policy is designed and implemented. An empirical investigation was conducted in a French region. We draw from eighty interviews with actors implementing health policy as well as on direct observation of a range of meetings and working sessions. Economic standards are a constraint for the actions of public health professionals: they force reforms, but they also determine the scope of reforms. Thus health policy is submitted to an economic prism that first affects the approach to public problems and second affects the forms of responses provided by actors. Beyond this cognitive and material constraint, the economic paradigm is so internalised that it becomes an integral part of health professionals’ activity. Therefore the material constraints take on the appearance of economic policy, in the sense that both the instruments of action and the very motivations behind that action are economically driven.